Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV
Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV
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DOI：
10.1097/qai.0000000000002204
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发表时间：
2019-12-01
影响因子：
3.6
通讯作者：
Nsanzimana, Sabin
中科院分区：
文献类型：
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作者：
Donenberg, Geri R.;Cohen, Mardge H.;Nsanzimana, Sabin
背景：撒哈拉以南非洲艾滋病毒青少年在坚持抗逆转录病毒治疗（ART）方面面临挑战。不良的心理健康状况会导致不依从，但可以通过认知行为疗法（CBT）来改善。同行提供的 CBT 可能会增强效果，同时建设低收入国家的维持能力。本案例研究回顾性地应用探索准备实施维持框架来描述基加利 Imbereheza 项目的执行情况，该项目是一项 2 组单独随机分组对照试验，由卢旺达青年领袖 (YL) 向感染艾滋病毒的青少年提供创伤知情依从性增强 CBT (TI-CBTe)。 方法：YL（n = 14，43% 女性，M = 22.71 岁）已确认感染 HIV 和自我报告的 ART 依从性 >95%。 HIV 感染者（n = 356，51% 为女性，M = 16.78 岁）被随机分配接受 TI-CBTe 或常规护理。两名 YL 共同主持了 TI-CBTe 会议，历时 2 个月，总计 12 小时，而其他 YL 则观察并评价保真度。参与者报告了 YL 的能力。其他数据评估了可行性、可接受性、接受度和保真度。结果：在探索阶段，焦点小组、利益相关者会议和个人访谈显示了对提供 TI-CBT 以减少青少年抑郁和创伤并提高 ART 依从性的强烈共识。准备阶段，进行了课程修订，成功培训了YL，建立了级联督导模式。在实施阶段，YL 在密切监控和监督下交付了 TI-CBTe。研究结果显示了很强的可行性、可接受性、吸收性和保真度，增加了维持的可能性。结论：探索准备实施维持可以指导实施计划和交付并评估实施结果。
Background: Sub-Saharan African adolescents living with HIV face challenges to antiretroviral therapy (ART) adherence. Poor mental health drives nonadherence but can be improved with cognitive behavioral therapy (CBT). CBT delivered by peers may strengthen effects while building capacity for sustainment in low-income countries. This case study retrospectively applied the Exploration Preparation Implementation Sustainment framework to characterize the execution of the Kigali Imbereheza Project, a 2-arm individually randomized group controlled trial of Trauma-Informed Adherence-Enhanced CBT (TI-CBTe) delivered by Rwandan youth leaders (YLs) to adolescents living with HIV.Methods: YL (n = 14, 43% female, M = 22.71 years) had confirmed HIV and self-reported ART adherence >95%. Participants (n = 356, 51% female, M = 16.78 years) living with HIV were randomized to TI-CBTe or usual care. Two YLs co-led TI-CBTe sessions over 2 months for a total of 12 hours, while other YL observed and rated fidelity. Participants reported on YL competence. Additional data evaluated feasibility, acceptability, uptake, and fidelity.Results: In the Exploration phase, focus groups, stakeholder meetings, and individual interviews revealed strong consensus for delivering TI-CBT to reduce adolescent depression and trauma and improve ART adherence. In the Preparation phase, curriculum revisions were made, YLs were successfully trained, and a cascading supervision model was established. In the Implementation phase, YL delivered TI-CBTe with close monitoring and supervision. Findings revealed strong feasibility, acceptability, uptake, and fidelity, increasing the likelihood of Sustainment.Conclusions: Exploration Preparation Implementation Sustainment can guide implementation planning and delivery and evaluate implementation outcomes.